Provider Demographics
NPI:1356181499
Name:JOHNSTON, ALEC
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3D MARINE RAIDER BATTALION
Mailing Address - Street 2:PSC BOX 20073
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0073
Mailing Address - Country:US
Mailing Address - Phone:561-281-7289
Mailing Address - Fax:
Practice Address - Street 1:3D MARINE RAIDER BATTALION
Practice Address - Street 2:PSC BOX 20073
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-0073
Practice Address - Country:US
Practice Address - Phone:561-281-7289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman